Provider Demographics
NPI:1518050210
Name:DOMANICO PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:DOMANICO PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOMANICO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-605-0817
Mailing Address - Street 1:200 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:630-605-0817
Mailing Address - Fax:847-221-4761
Practice Address - Street 1:355 WEST NORTHWEST HIGHWAY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067
Practice Address - Country:US
Practice Address - Phone:847-221-4700
Practice Address - Fax:847-221-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty